Terminal cancer patients' wishes and influencing factors toward the provision of artificial nutrition and hydration in Taiwan

Abstract

Identifying the concerns of terminal cancer patients and respecting their wishes is important in clinical decision-making concerning the provision of artificial nutrition and hydration (ANH). The aim of this study was to discover terminal cancer patients' wishes and determine influencing factors toward the provision of ANH. One hundred and ninety-seven patients with terminal cancer, admitted to a palliative care unit in Taiwan over a two-year period, completed a questionnaire interview, which included demographic characteristics, knowledge and attitudes on ANH, the health locus of control, subjective norms, and the wishes to use ANH. One hundred and fifty-four patients (78.2%) used ANH in the past month. A knowledge test on issues related to ANH showed the rates of accurate responses were ranked as: peripheral intravenous route can only provide hydration (48.7%), excessive artificial nutrition may increase the proliferation of cancer cells (32%), ANH can prolong life expectancy for all patients (17.3%), and ANH can prevent all patients from starving to death (5.6%). The strongest attitude of patients toward the potential benefit of ANH was "it can provide the body need with nutrition and hydration when inability to eat or drink occurs." Otherwise, the strongest attitude toward the potential burdens of ANH was "gastrostomy makes the illness worse." One hundred and twenty-two of 197 patients (62.9%) expressed their wishes to have ANH. The results of logistic regression analysis showed that the experience of using a nasogastric tube and intravenous fluids, and subjective norms were the most significant variables related to the wishes of patients to use ANH (odds ratio [OR]=11.11, 95% confidence interval [CI]=3.20-38.64; OR=2.51, 95% CI=1.22-5.15, OR=1.30, 95% CI=1.05 - 1.60, respectively). However, the use of artificial nutrition was negatively affected by the knowledge of ANH (OR=0.53, 95% CI=0.37-0.84). In conclusion, Taiwanese patients with terminal cancer have insufficient knowledge about AHN and still believe in the benefits of ANH, especially in avoiding dehydration or starvation. The findings of this study indicate the importance of medical professional training and decision-making in the initial consideration of using ANH. By improving the knowledge about ANH among patients, more appropriate decisions can be achieved. ? 2004 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.